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R. H. WAPPLER. SURGICAL INSTRUMENT. APPLICATION FILED OCT. 17, 1911.

Patented May 6, 1919. 2 SHEETS-SHEET l- R. H. WAPPLER. SURGICALINSTRUMENT. APPLICATION HLED OCT, 17. I917.

Patented May 6, 1919.

2 SHEETSSHEET 2 11v Vb TOR fim'zz/zold/f Wag?! 2m A TTORNE Y ed for usewhile the REINHOLD H. WAPPLEB, OF NEW YORK,

COMPANY,

N. Y., ASSIGNOR '10 WAPPLEB, ELECTRIC me, A oonronnrron or new YORK.

SURGICAL INSTRUMENT.

Specification of Letters Patent.

Patented May 6, 1919.

Application filed October 17, 1917. Serial No. 196,995.

To all whom it may concern:

Be it known that I, REINHOLD H. WAF- PLER, a citizen of the United$tates, residing in the city of New York, in the county and State of NewYork, have invented certain new and useful Improvements in SurgicalInstruments, of which the following is a full, clear, and exactdescription.

vMy invention relates'to surgical instruments of the kind associatedwith explorations of internal portions of the body, and performance ofoperations upon such portions while the same are subject to the actualview of the operator.

More particularly stated, I seek to provide a surgical instrument inwhich are effectively combined a cystoscope or its equivalent forenabling the operator to view directly various internal portions of thebody, for instance the bladder, and guiding mechanism to be'connected tothe cystoscope, and adaptcystoscope is in action,

for facilitating the introduction of exploring devices, and operatinginstruments, so

as to enable the operator to employ the same, and also to observe everystage of his work. While my invention is adapted for general use uponvarious internal portions of the body, it is of special service inconnection with diseases of nary organs.

In the surgical treatment of such diseases, there are in general threedistinct steps to be performed. First, the bladder and, parts adj abentto it must be inspected, y"-1neans of a systoscope or its equivalent.econd, one or more catheters mustbe inserted and actuated afterinsertion, in order tuienable the operator, by aid of the'cystoscope; tolocate the precise seat of the disease or obstruction sought, and alsoin some instances'to fa; cilitate thedischarge of urine from thebladder. Third, an operating instrument, of a character dependent uponconditions, must in some instances be inserted and used in accordancewith the surgical work found necessary.

Heretofore separate instruments have customarily been used forperforming the three steps above enumerated This has rendered themechanism complicated and expensive, and has prevented the reduction toa minimum the length of time required for an operation.

By my invention I employ a single cystothe bladder and other ur1- scopefor enabling the operator to make all necessary examinations andobservations, the cystoscope being provided with mechanical means forholding and guiding, in succession and if need be while the cystoscopeis in active use, first one or more catheters, and second an operatinginstrument of suitable form.

In other words I provide a eystoscope with means for enabling otherinstruments to be connected to it, these other instruments beinginterchangeable relatively to each other and thus employed.

Reference is made to the accompanying drawing forming a part of thisspecification, and in which like letters indicate like parts through allof the views.

Figure 1 is a fragmentary plan of my device, showing the cystoscope andparts accompanying the same as used with two flexible catheters.

Fig. 2 is a fragmentary side elevation of the mechanism shown in Fig. 1.

Fig. 3-is a fragmentary plan showingthe cystoscope as carrying twocatheters and a ide for the catheters, and also aclamp for holding theseparts together.

Fig. 4 is a section on the line 4-4: of Fig. 2, looking in the directionindicated by the arrows.

Fig. 5 is a section on the line 5-5 of Fig. 3, looking in the directionindicated by the arrows.

Fig. 6 is a perspective of the guide, exhibited alone.

Fig. 7 is aside view of my device, partly in elevation and partly brokenaway, showing how the operating instrument is inserted and guidedwithout interference with the cystoscope. Fig. 8 is a fragmentary sideelevation showing the device as used when the cystoscope and theoperating instrument, are in active use at the same instant.

Fig. 9 is a section on the line 9--9 of Fig. 3,.looking in the directionindicated by the arrows. I

- A metallic sheath is shown at 9, and has a general tubular form, beingprovided with an axially disposed bore- 10 having an ellipticalcross-section, as shown more particularly in Fig. 4.

The shea h 9 is provided end portion 11, carrying a lamp 12.

with an upturned tuny incandescent A cap 13, earned by th upturned endportion of the sheath, is detachable in order to facilitate the removaland replace ment of the lamp. This cap 13 also constitutes a tip for theend of the sheath, and for this purpose is rounded.

The sheath 9 is providedwith a slot 14 merging laterally into the bore10, and with an opening 14 which is merely one extremity of the bore 10,as may be understood rom Fig. 2;

The sheath 9 16. The sheath is further provided with a short tubularportion 17, detachable .from the main or' body portion of the'sheath,and carrying valves The sheath is further provided with a collar 20, andwith insulating members 21, 22

whereby this collar is insulated from other parts of the sheath.Electrical connections are shown at'23, 24 and are provided with contactportions 25, 26, the latter engaging respectively the portions 15 and 20of the sheath and being movable relatively thereto. The electricalconnections may be turned bodily around on the axis of the sheath as acenter,'- this purpose being facilitated if need be by use of the milledring 16, which is fixed relatively to the sheath. An insulated conductor27 is connected to the collar and therefrom extends through asmallpassage 28 to the incandescent lamp 12, for the purpose of causing thesame to be illuminated. he parts are so proportioned, shaped andarranged that when the sheath is empty its bore is totally free from anyobstructionfrom end to end.

The barrel ofthe cystoscope is shown at 29..and carries a lens mounting30, containing a spheroidal lens or other lens of the i kind usuallyemployed as the object lens of a cystoscope.

The barrel 29 is mounted upon a tubular stock 30, carrying a head 31 andmilled rim 32, through which passes the axis of'the cystoscope barrel,this axis being the line of sight of the operator as he looks throughthe cystoscope. Thetubular stock 30 extends through a closure plug 33,as shown more particularly in Figs. 2 and 3, the axis of the stock notbeing exactly in the center of the plug, but a little eccentric thereto,so that when the closure plug is fitted into the tubular ortion 17 thebarrel of the cystoscope is in t e upperportion of the sheath. This isindicated in Figs. 2, 4. 7 and 8.

The closure plug 33 .is provided with a head 34 of substantially annularform, this head being eccentric to the axis of the stock 30 andtherefore parallel to the optical axis of the cystoscope.

Extending from the head 34 is a middle tube 35 and two side tubes 36,37. Each of these three tubes leads into a single passage isfurtherprovided with an enlarged portion 15 and with a milled ring 18,19 for discharging urine.

catheters are each of tubular form 33 (see Fig. 9) with which theclosure plug 33 is provided. The passage 33* is of cylindrical form, solocated that when the closure plug is inserted into the tubular member17, as indicated in Figs. 1, 2 and 8, the passage 33 merges into thebore of. the sheath, that is, into the lower portion of the bore whenthe sheath is in its normal position. An obturator is shown at 38,and.,is simply a rubber cap for closing the outer or free end of thetube 35 when this tube is not inuse. The obturator closes the tubewatertight'and air-tight. Another obturator 39, similar in form but ofsmaller size, is used for closing either of the smaller tubes 36, 37 Twocatheters are shown at 40, 41. These and flexible. As here shown theyare unlike in color so as to be readily distinguishable by sight. Thisis not essential and they may if desired be exactly alike.

For the purpose of holding the closure plug 33 I member 17 I provide thehead 34 with a form 42 carrying a pin 43, and upon the top of thetubular member 17 I mount a revoluble locking member'44, provided with ahandle 45; The locking member 44 is actuated by the handle 45 for thepurpose of gripping and releasing the pin 43. Thus the parts 42, 43, 44and 45, together, constitute a clutch, for holding the closure plug 33in a predetermined normal fixed position relatively to the sheath andparts carried thereby. I I 1 A guide 46, shown in its entirety in Fig.=6 and. in this instance made of sheetmetal, is adapted for attachment tothe cystoscope barrel. A central rib 47 is provided with a pair oflaterally extending wings 48, integral with it. The wings 48 are eachcurved in cross-section, as may be understood from. Figs. 4 and 5.Preferably a single strip of sheet metal is bent .back upon itself toform the rib, the edges of the strip being then bent outwardly from eachother, slightly curved, to form the wings. The rib is also provided witha notch 49, and with a clip 50 disposed adjacent this notch and solderedupon the upper surface of the wings. The clip has the form of a splitcylinder, and may be sprung slightly so as to grip the barrel of thecystoscope.

he guide 46 also carries a fin 51, which is merely a thin bladeextending from one end of the rib 47, as shown in Fig, 6.

and is so formed and arranged as to extend nto the passage 33" Wheneverthe guide 46 is mounted upon the cystoscope barrel as in proper relationto the tubular -fin is virtually a continuation of the rib 47,

shown fonlnstanc'e in Figs. 1 and 3. The

manner in whichjthe passage 33 is, divided or cloven by thefin is shownmore particularly in Flg. 9. The purpose of this ar til they protrudefrom I 9, then pulls scope barrel .scope in place rangement is tofacilitate the insertion of the flexible catheters 40, 41 through thetubes 36, 37 and to direct each catheter into proper sliding engagementwith the guide 46. The rounded surfaces bf this guide, due to curvatureof the wings 48 as shown in Fig. 4, still further facilitates the freemovements of the catheters, as a semi-rounde passage is thus providedfor each of the two catheters.

In practice it is sometimes convenient to attach the catheters to theguide 46 so as to facilitate the insertion of both the guide and thecatheters, as practically a unit, into the sheath. For this purpose Iemploy a clamp 52, shown more particularly in Figs. 3 and 5. This clampis made of spring sheet metal, and isprovided with jaws 53, '54. The jaw53 is fashioned to fit upon the barrel 29 and clip 50, the jaw 54 beingof proper fo m to fit against the under side of the two catheters 40, 41while the latter ment with the guide 46. With the parts 1n this positionthe jaw 54 extends through the notch 49 and is thus ping or moving alongtheguide 46.;

With the parts thus arranged the operator can thrust the free end ofthecystoand the adjacent ends ofthe guide 46 me those of the two cathetersinto the sheath 9, and then by removing the clamp 52 he can push thecystoscope barrel, accompanied by the guide and catheters, unthe distantend 0 the sheath, as indicated in Figs. 1 and 2 Thus the closure plug 33is brought to fit into the tubular member 17 and thus locked by means ofthe clutch, as above described. In order to remove the catheters andguide, the operator withdraws them, to-

ether with the cystoscope, from the sheath the catheters out cystoscopebarrel.

- The cystoscope alone, catheters and guide, may be thrust through thesheath 9 a'sjindicated' in Fig. 7 and in such event the barrel of thecystoscope assumes a definiteposition within the upper half of the bore10, the bottom half of this bore being unobstructed. With the cystothebarrel 29 always occupies this exact-position, whether the catheters andguide be present or not. This may be understood from Figs. 4 and 7.

With the parts arranged as indicated in Fig. 7, an operating ble thatis, without the instrument of suita form can be thrust throughthe tube35 and thus guided inserted farther until its free end from the opening14.

One form of operating instrument, suitable for this purpose and known asforceps, is shown in Figs. 7 and 3. This instrument protrudes comprisesa flexible body portion 55 and handle 56, both of tubular Any other i I,For purposes of catheteriz ation are 'arran ed as above described withreferare in engageprevented from sl1pgagement with differentphysiological the operatin of the tubes 36, 37, and disconnects the clip50 from the V the free end of the sheath.

into the bore 10,.and then gently form. Through the body portion andhandle extends an actuating wire 57 to which is connected a pair of jaws58. For securing the wire and tightening it there is a thread 59 and nut60. form of operating instrument, however, may be used, provided onlythat.

I it will admit of insertion through the tube 35 and bore 10. y Theoperationof my device is as follows: the parts ence to igs. 1 and 2. Theoperator now grasps the ends of the catheters protruding from the tubes36, 37, and by pulling the catheters he moves them slightly endwise, sothat their opposite ends are housed within the adjacent end of thesheath. The instrument is next inserted throu h theurethra and into'thebladder. Next the incandescent lamp is caused to glow, electric currentthrough the electrical connections which are in' turn energized from anysuitable source of current. I r

The operator now looks through the cystoscope and by manipulation of thecatheters he inserts them into the ureters or into enparts in which theexistence of disease is suspected. He thus makes a thorough exploration.He may use one or both catheters, as he may see proper, and he has adirect view of the parts as pressed open or otherwise ma nipulated bythe catheter or, catheters,-

Having thus determined the seat of the disease, the operator mayconcludeto use I instrument. For this purpose he actuates t e clutch inorder to release the closure plug 33 and then withdraws this closureplug, together with the cystoscope barrel and parts carried thereby. Henext for this purpose being supplied disconnects the guide andcatheters, and y then replaces the closure plug, together with thecystoscope barrel carried by it, and actuates the clutch so as to againlock the closure plug in position. This leaves the apparatus in thecondition indicated at the right of Fig. 7, the cystoscope barreloccupying the upper half of the bore 10. The operator now insertsinstrument. If'this happens ceps above described, he inserts the jaws 58through the tube 35 and by feeding the body portion 55 into this tube asuilicient distance, he brings the jaws 58 out toward Next the operatorinserts the sheath and its accompanying parts through the urethra andinto the bladder. The incandescent lamp is next caused to glow, and asthe operator looks through the cystoscope be actuates the operatinginstrm'nent. Suppose he sees in the bladder or in one of the uterers agall stone. He so aet'uates the operating instrument as to the operatingto be the forcause the jaws 58 to clasp "the stone, which gagement withsaid longitudinal guide, of a thereupon is easy to dislodge by simplypair of flexible catheters. pulling upon the operating instrument. 5. Ina device of the character described This done, the entire apparatus isremoved the combination of a sheath carrying a lamp bodily, the gallstone-coming out with the and provided-with a bore, a cystoscope forforceps. extending through said bore, means for guid- Other operatinginstruments of different ing into said bore a pair of flexiblecatheters, kinds may be thus used for different pur and a guideremovably housed Within said poses, as for instance treatment of lesionsby bore in order to facilitate the travel of means of an electric. sparkor by local apflexible exploring members through said 7 plication ofmedicines. bore, said guide being for this purpose pro- I donot limitmyself to the precise mechvided with a partition and with rounded anismhere shown, as variation therein may portions extending from saidpartition. be made without departing from the spirit 6. In a device ofthe character described of my invention. the combination of a sheathprovided with a claim v bore, a closure plug detachably-engaging 1. Thecombination, with a sheath carrysaid sheath and provided with a passagefor ing a lamp and provided with a bore, of a communicating with saidbore whenever said cystoscope detachably supported by said closure plugis in fitting engagement with sheath and provided with a barrel portionsaid'sheath, said closure plug being also proextending through saidbore, aguide detachvided with a guiding tube communicating ably securedto said barrel portion of said with said passage in order to facilitatethe cystoscope and provided with a partitioning introduction of an Ioperating instrument member, and a plurality of flexible operatthroughsaid passage and into said bore, ing members to be thrust through saidbore said closure plug being further provided and guided by saidpartitioning member. with a plurality of additional guiding tubes 2. Thecombination, with a sheath carrycommunicating with said passage tofaciliing a lamp and provided With a bore, of a tate the introduction offlexible exploring cystoscope mounted upon said sheath for enmembersthrough said passage and into said abling the operator to see throughsaid bore, bore while said operating member is not in and a guidedetachably mounted upon said said bore, and a guide to be fitted intosaid cystoscope and located within said bore, said bore while saidoperating instrument is abguide having a rib and a pair of wings forsent from said bore, said guide having a the purpose of partitioning offdiffer'entporpartition for-demarking the respective paths tions of saidbore. of travel of said flexible exploring members,

3. Ina device of the character described and also having a fin forextending into said the combination, with a sheath carrying a passageand serving therein as a partition lamp and provided with a longitudinalbore, for guiding said flexible exploring members of aclosure plug forfitting-into said bore, through said passage. 7 and a cystoscopesupported by said closure 7. The combination, with a sheath carryplugfor enabling the operator to see through ing a lamp and provided with abore, of a 7 said bore, said closure plug being provided closure plugengaging said sheath, a cystowith means for enabling flexible operatings ope carried by said plug and extending members to be thrust through itand into through said bore, and a guide provided said bore, and guidingmechanism located. with means for detachably holding it upon within saidbore for guiding said flexible said cystoscope, for the purpose ofguiding operating members therein. transient exploring members whenthrust 4 In a device of the character described int aid bore. thecombination, with a sheath carrying a 8. In a device of the characterdescribed lamp and provided with a bore, of a closure the combination,with a sheath carrying a plug detachably engaging said sheath, a lampand provided with a longitudinal bore, cystoscope carried by saidclosure plug and of a closure plug for fitting into said longiextendingthrough said bore whenever said tudinal bore,a cystoscope extendingthrough closure plug is in fitting engagement with said closure plug andsupported thereby, a said sheath, a guiding tube carried by said guideseparate from sald cystoscope and de closure plug for directing anoperating 1ntachably mounted thereupon for extend ng strument into thebore of said sheath, a loninto said bore, and a plurality of guidinggitudinal guide provided with means for detubes carried by said closureplug and protachably securing it upon said cystoscope in vided with aplurality of passages merging order to facilitate the introduction ofsaid together for the purpose of guidingtransient guide along with saidcystoscope into said members into said bore when said closure borewhen-said operating instrument is not plug is fitted into said bore. inuse, and a pair of guiding tubes carried 9. In a device of the characterdescribed bv said closure plug to facilitate the introthe combination,with a sheath carrying a dhction into said bore, and into sliding enlampand provided with a longitudinal bore,

' with a central passage and with means of a closure plug for fittinginto said bore and a cystoscope supportedby said closure plug forenabling the operator to see through said bore, said closure plug beingprovidfed or guiding flexible operating members through said centralpassage and into said bore, and a guide detaohably mounted upon saidoysto-- scope for extending therewith into said bore when said bore,said guide having a fin closure plug is fitted into said 10 forextending into said central opening of said closure plug in order tohers.

guide the flexible operating mem- REINHOLD H. WAPPLER.

